Provider Demographics
NPI:1659042810
Name:BINGHAM, RENITA RAI (MA)
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:RAI
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6146 SIERRA PASS
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2134
Mailing Address - Country:US
Mailing Address - Phone:810-962-1609
Mailing Address - Fax:
Practice Address - Street 1:2425 S LINDEN RD STE D
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5474
Practice Address - Country:US
Practice Address - Phone:810-597-9331
Practice Address - Fax:888-534-5222
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional